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Imagine this: An implant surgeon is performing a thorough examination of your mouth. The surgeon rotates your jaw from side to side and up and down, looking for the optimal sites in which to place dental implants — and the proper size, shape and orientation for the implants to have. He or she may test several alternatives, considering the underlying anatomical structures, and the bone density and quality that the examination reveals. Finally, a surgical plan is developed: This includes a set of precise specifications for implant position, size and depth, and a template for creating a perfectly fitting set of replacement teeth. But no invasive procedures of any type have been performed so far. In fact, you aren't even present.

Welcome to the world of computer-guided dental implant surgery. What we have described is one step in the process that allows you to receive a set of replacement teeth with the minimum amount of surgery (and time spent in the dental chair), and the maximum level of preplanning foresight. It can result in faster overall treatment time, less discomfort, and an outcome that pleases everyone. Let's look a little more closely at the entire process of computer-guided implant surgery — a procedure at the forefront of dental implant technology.

The First Phase: Making A Virtual Model

It all begins with a complete examination and modeling of your existing teeth, gum and jaw structures. In many cases, a physical impression (replica) of the jaws is made, which will aid in planning the location of the new teeth. But the modeling doesn't stop there: A high-tech, three-dimensional CT (computed tomography) scan is also performed. This allows us to examine the structures (including bone, nerve tissue and sinus cavities) which lieinside the jaw. It is often accomplished using “cone-beam” CT technology, in which the scanning device quickly captures a complete digital image of internal structures as it rotates around your head.

The next step of the process relies on powerful computers and sophisticated software to take the raw CT scan data and translate it into a 3-D model of the jaw. This virtual model can be manipulated on a computer screen — rotated, measured, even “operated” on — so that we can visualize the placement of dental implants and determine their optimum position with a high degree of accuracy. Using this technology, it's now possible for us to evaluate anatomical structures virtually — structures it once would have taken surgery to reveal — and to plan out the implant procedure accordingly.

The 3-D model we have developed is then used for two purposes: to create a precise guide for the implant surgery, and to allow the dental laboratory to pre-manufacture a set of replacement teeth that will fit precisely in the jaw. An advanced set of CAD/CAM (computer aided design/manufacture) processes is used to generate the physical objects — in this case, the surgical guide and the prosthetic teeth. Depending on your individual situation, the new teeth may be attached the same day as implant surgery, or after a healing period of 6 to 12 weeks. In either case, our precision modeling ensures that they will fit perfectly with the implants and the jaw.

Implant Surgery: Following the Plan

The implant surgery itself is typically performed under local anesthesia, and often requires no sutures (stitches). In the surgical procedure, the template we have produced (which resembles a nightguard or athletic mouthguard) is securely (but temporarily) fixed in position on the jaw. The openings in this template form precise guides for the placement of the implants — accurate in terms of position, width and depth. In fact, the implants fit so perfectly into these prepared sites that we can have new teeth placed the same day as implant surgery.

Since so many of the details have been accomplished in the planning stages, computer-guided implant surgery is typically uneventful for the patient. It can result in shorter time in the chair, less discomfort during recovery — and a highly pleasing result. It has even been called the most significant innovation in implant technology since osseointegration — the fundamental process by which a dental implant becomes fused with the bone.

What is bone grafting?

Bone grafting is a minor surgical procedure performed in the dental office under local anesthesia to rebuild bone in areas where it has been lost. Grafting material can be placed into a tooth socket as soon as a tooth is extracted, or in an area where a tooth has been missing for some time. Your body will then grow new bone cells, replacing this graft material over the next several months.

Why would I need this procedure before getting a dental implant?

A dental implant should last a lifetime. In order to do so, however, it needs to fuse securely to your jawbone. If you have insufficient bone volume there, your chance for success with dental implants won't be as high as it should be. Why would this happen? Bone quality and quantity almost always deteriorate when a tooth is lost, though you may not notice this is happening. Sometimes, by the time a person decides to have an implant placed, there may not be adequate bone left to ensure success. That's why we often need to place a graft first. That's also the reason you should replace a tooth as soon as possible and why many dentists recommend placing a bone graft at the time of extraction (View Step by Step Example).

Where does the grafting material come from?

It can come from a variety of sources, including your own body. These days, however, laboratory-processed bone from a human or animal donor (usually a cow), as well as synthetic materials, are frequently used.

Is it safe?

There are no safety concerns with grafting material that come from your own body. However, this method does have a disadvantage in that it involves creating a second surgical site — the place from which the bone is obtained. Mineral bone substitutes, whether they are coming from human donor bone or animal bone, pose little risk of infectious disease transmission as they undergo meticulous safety screening. Both have a similar level of risk, due to the extensive and rigorous processing the material undergoes at the highly reputable tissue banks used. This results in graft materials that have proven to be extremely safe. Also, you may be interested to know that mineral graft materials do not remain in the body but are naturally absorbed and replaced by your own bone over time.

Does the procedure hurt?

Bone grafting involves a small incision in the gum to gain access to the bone beneath it. Therefore, you may experience some post-operative soreness. Most people find this can be managed with ice packs applied to the jaw and over-the-counter anti-inflammatory medication and/or pain relievers.

How long does it take to heal?

You should feel back to normal in a day or two. But at this point the bone-regeneration process will have only just begun. Over the next several months your body will continue to deposit new bone cells and remove the grafting material.

Can my body reject the graft?

No, because it does not contain any genetically coded or living material — only minerals. The sole issue is how much bone your body will make in response to the graft. If the appropriate level has not been achieved by the time the graft has healed, more grafting material can be added at the same time the implant is placed.

Related Articles

Bone Grafting - Dear Doctor Magazine

Can Dentists Rebuild Bone? Yes they can! It is very important to maintain bone volume following removal of a tooth so that dental implants remain a viable option for tooth replacement. This is easily accomplished with today's routine bone-grafting techniques... Read Article